Paramedic Fees : Hawthorne Moves to Join Trend

Members of the Hawthorne City Council did not seem surprised when Roger L. Milstead, the city’s chief of fire services, recommended that the city start charging fees for paramedic services.

Nor did they seem fazed when Milstead explained at a meeting two weeks ago that, based on figures from other cities, he expected at least 70% of those using the services not to pay the fees.

With the city facing budget constraints and the Fire Department needing a second paramedic unit, Milstead told the council, the fee program is the city’s best way of raising funds despite the low projected collection rate.

In proposing to charge users $150 for transportation to a hospital and up to $175 for paramedic medical services, Hawthorne is moving to join many other cities that have begun charging for paramedic services. In the South Bay, fire departments in El Segundo, Gardena, Hermosa Beach, Inglewood, Los Angeles and Manhattan Beach charge for paramedic services when transportation is included.

Elsewhere in Los Angeles County, many cities--including Monterey Park, Compton, Montebello and Pasadena--charge fees for transport or medical attention or both, according to Capt. Eugene McCarthy, a paramedic coordinator for the county Fire Department, which does not charge for paramedic services.

‘All Around the Country’

“It’s not just here. It is all around the country,” McCarthy said. “Everyone has to deal with a growing number of calls on the same budget.”

And even the low collection rate is not unusual.

In Hermosa Beach, the Fire Department collects only 30% of its paramedic fees, while Inglewood collects 20% to 30%, according to officials in those cities.

“I would prefer a 100% collection rate,” said Steve Wisniewski director of public safety for Hermosa Beach. “But 30% to 40% on average is the rule of thumb.”

No paramedic program relies solely on fees, and none is in danger of going out of business because of the low collection rate, officials said. They said their cities could increase revenues with more aggressive collection tactics--such as using a collection agency or phoning people with delinquent accounts--but argued that this is not politically feasible.

In the South Bay, only Manhattan Beach, which has a collection rate of 80%, Gardena, with 65%, and El Segundo, with 62%, use collection agencies to pursue delinquent accounts.

In every city except El Segundo, billing for paramedic fees is handled by the city finance department. Paramedics in these cities transport only in emergencies and only when a private ambulance service is not available. Cities that don’t use collection agencies usually send only two or three notices before giving up on delinquent accounts, officials said.

The city of Los Angeles collects about 60% of paramedic fees without a collection agency. June Andrade, chief clerk for ambulance billing, said the city prefers to send notices and sometimes make phone calls to those who fail to pay instead of using a bill collector.

“These people have just been through a trauma, and you don’t want to add to that” by calling a collection agency, she said. “Some of the patients are elderly who don’t know where their next meal is coming from.”

In Inglewood, Division Fire Chief Robert Bean said: “Right now it would be politically unfeasible” to be more aggressive in collecting the fees.

“If you are running a business, you have to do it to survive,” Bean said. “But we are not a business. We take (the balance of the funds for the program) out of the taxes we charge.”

‘Frustrating’ Procedures

But Vivian Murillo, Inglewood’s revenue supervisor, called the city’s collection procedures “frustrating.”

“There has never been an attempt by anyone to go out and collect the fees,” she said.

In Hermosa Beach, which began a fee program in December of 1982, the fees collected “don’t make a dent” in the cost of running the paramedic program, said Paul Hawkins, the city’s paramedic coordinator.

The city collected $7,700 in fees last year but spent $53,000 to run its paramedic program, which includes one transport vehicle and seven paramedics, officials said. This amount does not include the salaries the paramedics receive for carrying out their regular duties as firefighters.

Hawkins said many people served by paramedics are tourists and people who work in Hermosa Beach but live elsewhere. After these people leave the city, they become difficult to contact, he said.

‘Negative Impact’

“We get vacationers from all over the world,” he said. “The city gets more vacationers, and we feel the negative impact.”

Inglewood also has a problem collecting fees from transients.

“We get many people coming into Hollywood Park and the Forum,” Bean said. “These people who use the services are hard to contact once they leave the city.”

It costs the city $900,000 a year to run the paramedic program, Bean said. Inglewood collected $28,000 in fees last year.

In El Segundo, the Fire Department’s collection rate of 62% is considered good, said Fire Chief Robert Marsh. When the city began charging fees for paramedic services in August, 1987, he said, it anticipated collecting only 50%.

Simplified Forms

Although the fee program means more paper work, Marsh said the paramedics have not complained. “We have simplified the (billing) form,” he said. “But obviously it is another layer of paper work to deal with.”

In Gardena, which charges the least among South Bay cities for paramedic services ($55 for transportation and medical services), the collection rate is 65%, said Battalion Chief Gary Roeber.

The low fees are one reason Gardena’s collection rate is higher than many of other cities’, he said. The fees are usually paid for by Medicare or Medi-Cal.

And, Roeber said, “we have a large population of Asians . . . and they pay their bills.”

In Manhattan Beach, where the paramedic program began charging fees as early as the mid-1960s, the city collected $23,000 in fees last year.

Fire Chief Keith Hackamack said the collection rate is high because “there are not a lot of transients here, not a lot of people who would abuse the program. We have the type of people that pay their bills.”

PARAMEDIC SERVICE FEES

City Residents Non-residents El Segundo $0 $120 Hermosa Bch. $65 $105 Inglewood $90 $110 Manhattan Bch. $78 $125 Gardena $55 $55 Los Angeles * *

Other South Bay cities do not charge for paramedic services.

* Fees depend on services and situation. The average cost is $85, and $100 when a helicopter is used.